Individual
DR. STEPHANIE M DETTLEBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1925 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-3128
(303) 776-1234
(720) 494-3107
Mailing address
1925 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-3128
(303) 776-1234
(720) 494-3107
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2009012781
MO
207Q00000X
Family Medicine Physician
Primary
DR.0057193
CO
Other
Enumeration date
11/29/2006
Last updated
07/12/2016
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